Recent development in hypertension gene study / 中国实用内科杂志

Genetic as well as genomic study has advanced the development of precision medicine. We are marching on the road for right patients who are receiving more and more right treatment at right time. In hypertension field, precision medicine is available, actionable and affordable. First and the most practical advancement is monogenic hypertension, the disease-genes have been found for at least 17 types of monogenic hypertension. These patients can be precisely treated according to their carried gene mutation. Secondly, pharmacogenetic and pharmacogenomic guided anti-hypertensive drug selection, very promising but lack of clinic outcome data to support widely clinical application. Majority of hypertension are due to multiple genetic and environmental factors. GWAS fund some genetic variants related to primary hypertension, but these variants can only be responsible for 1-10% of blood pressure variation. We have a long way to go in exploring the real cause of primary hypertension.

Changes and enlightenment of diagnostic criteria for hypertension / 中国实用内科杂志

The definition of hypertension has been the object of controversy for many years. The First Report of the Joint National Committee( JNC-1) on Detection, Evaluation, and Treatment of High Blood Pressure was issued in 1977 and the levels of blood pressure above 160/95 mmHg was considered as high blood pressure(BP). The early JNC series guidelines are relatively vague on the diagnostic criteria and treatment goals of hypertension, and put more emphasis on diastolic blood pressure(DBP) in hypertension diagnosis. Since the publication of JNC VI reports, hypertension is defined as office systolic blood pressure(SBP) values≥140 mmHg and/or DBP values≥90 mmHg. The 2017 ACC/AHA Hypertension Guidelines changed the diagnostic criteria for hypertension by 130/80 mmHg and has caused widespread controversy at home and abroad. The Chinese Medical Doctor Association issued a scientific statement on the diagnostic criteria for hypertension and treatment targets of high BP in China. Although the standards proposed by the new ACC/AHA hypertension guideline is not recognized by other national guidelines, its concept of earlier prevention of hypertension has been widely accepted.

Effects of television viewing on body fatness among Chinese children and adolescents / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Numerous studies have shown that time spent on television (TV) viewing is positively associated with obesity. The aim of this study was to examine the potential association between excessive TV viewing and obesity, especially abdominal obesity, among children and adolescents in mainland of China.</p><p><b>METHODS</b>A total of 4708 children and adolescents aged 6 to 16 years were recruited for the study. Anthropometric measures were conducted by trained personnels. A self-report questionnaire was designed to gather information on TV time, physical activity, diet habits, maternal body mass index (BMI), birth weight, and on general demographics, including age and gender, and socio-economic status.</p><p><b>RESULTS</b>The prevalence of obesity in this group was 6.5%. Linear regression analysis indicated that high TV viewing time (≥ 1.5 h/d) was significantly associated with higher BMI, waist circumference (WC), and waist-to-height ratio (WHtR). In addition, the high TV time group had 1.3 times the odds of obesity as compared to the low TV time group. Likewise, high TV viewing time increased the OR value 1.32 and 1.21 times higher in WC- and WHtR-defined obesity. Within the non-obesity group, high TV viewing time was also positively associated with higher WC and WHtR. All these correlations remained significant after adjustment for the confounding variables.</p><p><b>CONCLUSIONS</b>Excessive TV viewing might increase the risk of obesity among Chinese youth. Reducing TV viewing time may be beneficial to improve health outcomes, both in the short- and long term. This finding should be taken into account in future designs of intervention policies to prevent childhood and adolescent obesity in China.</p>

Comparison on efficacy and safety between domestic levosimendan versus dobutamine for patients with acute decompensated heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy and safety of domestic levosimendan versus dobutamine for patients with acute decompensated heart failure (ADHF).</p><p><b>METHODS</b>ADHF patients from 8 medical centers were recruited in this multicenter, blind, positive-controlled, randomized study and received 24 h intravenous levosimendan (n = 114) or dobutamine (n = 114) therapy. SWAN-GANZ catheter was performed in patients with pulmonary capillary wedge pressure (PCWP) ≥ 15 mm Hg (1 mm Hg = 0.133 kPa) and cardiac index (CI) ≤ 2.5 L·min(-1)×m(-2) (n = 39 each).</p><p><b>RESULTS</b>Compared with baseline level, LVEF increased [(31.56 ± 9.69)% vs. (28.44 ± 7.08)%, P < 0.01] at 24 h in both groups. LVEF increase at 24 h was similar between two groups [(3.11 ± 6.90)% vs. (3.00 ± 6.63)%, P > 0.05]. The PCWP decrease at 24 h was significantly greater in levosimendan group than in dobutamine group [(-8.90 ± 7.14) mm Hg vs. (-5.64 ± 6.83) mm Hg, P = 0.04]. Decrease in NT-proBNP at 3 days was also more significant in levosimendan group than in dobutamine group [the percentage change compared to baseline: (-22.36 ± 38.98)% vs. (-8.56 ± 42.42)%, P < 0.01]. Dyspnea improvement at 24 h was more significant in levosimendan group than in dobutamine group. The incidences of adverse reactions and events were similar between two groups.</p><p><b>CONCLUSION</b>LVEF improvement is similar between dobutamine and domestic levosimendan while greater decreases in PCWP and NT-proBNP are achieved with domestic levosimendan in patients with ADHF.</p>

Association of tag SNPs of GPx-3 with essential hypertension in rural Han Chinese in Fuxin, Liaoning, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Genetic mechanisms contribute to blood pressure regulation. This study investigated whether glutathione peroxidase (GPx-3) tag single nucleotide polymorphisms (SNPs) are associated with hypertension in the rural areas of Fuxin county, Liaoning province, China.</p><p><b>METHODS</b>Indigenous Fuxin Han people participated, 523 unrelated hypertensives and 547 controls were recruited. All tag SNPs of GPx-3 gene were selected. We estimated SNP allele frequency in DNA pools with pyrosequencing.</p><p><b>RESULTS</b>Before Bonferroni correction, C allele frequency for rs8177417 was significantly higher in hypertensives than those in controls (23.4% vs. 19.3%, P = 0.014); T allele frequency for rs3828599 was significantly lower in hypertensives than those in controls (35.6% vs. 40.8%, P = 0.009). However, when a Bonferroni correction for multiple testing was applied, only the polymorphisms rs3828599 of GPx-3 gene was associated with hypertension (P = 0.045, OR: 0.833, 95%CI: 0.695 - 0.998).</p><p><b>CONCLUSION</b>The polymorphism of rs3828599 of GPx-3 gene might be associated with hypertension in rural Han Chinese from Fuxin, Liaoning.</p>

Prevalence, awareness, treatment and control of hypertension in rural adult residents of Liaoning Province / 中华心血管病杂志

<p><b>OBJECTIVE</b>The objective of this study was to estimate the current status of prevalence, awareness, treatment and control rate of hypertension in adult residents living in rural area of Liaoning Province, North China.</p><p><b>METHODS</b>The screening was finished in 2008, probability proportional to size sampling method was used to select the representative sample. Blood pressure was measured in 153481 adults (aged > 35 yr), information on history of hypertension and use of antihypertensive medications was obtained by use of a standard questionnaire.</p><p><b>RESULTS</b>Overall, hypertension prevalence rate was 41.9%, the age-specific hypertension prevalence rate was 25.0%, 37.7%, 50.2%, and 64.9% in men and 22.1%, 41.1%, 56.6% and 70.2% in women age 35 to 44 years, 45 to 54 years, 55 to 64 years, and above 65 years, respectively. Among hypertensive patients, awareness rate was only 54.1%, 39.7% patients received antihypertensive medication and blood pressure control rate (< 140/90 mm Hg) was 6.9% in all participants and was 9.3% in treated hypertensive patients.</p><p><b>CONCLUSION</b>Our results indicates that hypertension prevalence is highly while awareness, treatment and control rate of hypertension was low in rural areas of northeast China. These results underscore the urgent need to develop comprehensive strategies to improve prevention, detection, and treatment of hypertension in rural population of Liaoning province.</p>

Analysis of therapeutic effects of rural patients with hypertension by combination administration of low dosage of hydrochlorothiazide and nitrendipine / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of combination administration of hydrochlorothiazide and nitrendipine at low dosage in the treatment of rural hypertension patients.</p><p><b>METHODS</b>By the method of cluster random sampling, 5292 primary hypertension patients from Fuxin, Liaoning Province were divided into health education group (control group) and drug intervention group in June 2006. The drug intervention group were treated with hydrochlorothiazide, nitrendipine and captopril by stepwise approach and we observe the antihypertensive effect of drug and the effect on the onset of stroke.</p><p><b>RESULTS</b>The average follow-up time was 15 months. At last, 308 patients were lost to follow-up (the lost follow-up rate was 5.8 percent). The 4984 in cohort, including 2530 of intervention group and 2454 of control group, had examination of all indicators. Through health education and drug intervention, the average blood pressure in drug intervention group decreased by 16.1/9.4 mm Hg (1 mm Hg = 0.133 kPa) while the average blood pressure in control group decreased by 6.7/3.5 mm Hg. The control rate of blood pressure in drug intervention group was higher than control group (33.1% vs. 15.1%, P < 0.001). Through drug intervention, the morbidity risk of nonfatal stroke in drug intervention group decreased by 57.3% compared to control group, the total morbidity risk of stroke decreased by 59.4%. The results had significant statistical difference. And, the morbidity of severe hypopotassaemia (K(+) < 3.0 mmol/L) and diabetes mellitus had no significant statistical difference between two groups.</p><p><b>CONCLUSIONS</b>The low-cost antihypertensive program based on thiazide had good antihypertensive effect, high safety and good cost-effect ratio. The program could be used in rural areas of China.</p>

Correlation between body mass index, waist circumference and blood pressure in rural residents from west part of Liaoning Province / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study observed the association between body mass index (BMI), waist circumference (WC) and blood pressure level in rural residents from west Liaoning province.</p><p><b>METHODS</b>This epidemiological study using stratified cluster random sampling was conducted from 2004 to 2006 in Fuxin County, Liaoning Province, 43,692 rural residents (21,680 males) aged 35-74 years old [(49. 8 +/-10.2) years] were surveyed. Database was established with the help of Epidata 3.1 software.</p><p><b>RESULTS</b>In total 43,692 persons were surveyed, including 21,680 male (49.6%) and 22,012 female (50.4%). The average BMI and WC was (23.31 +/- 3.08) kg/m2 and (80.87 +/- 9.0) cm, respectively. No matter male or female, SBP started from 20 kg/m2, increased with the increase of BMI; DBP increased gradually with the increase of BMI; the prevalence of hypertension were significant differences among different BMI groups (P < 0.001). Multiple logistic regression show that in male, using the group with BMI, <18 kg/m2 as control, 28-30 kg/m2 group OR and 95% CI was 6.285 (4.612-8.566); in female, when BMI >22 kg/ m2 OR increased with the increasing of BMI. In male and female, both SBP and DBP, also the prevalence rate of hypertension increased gradually with the increase of WC (P < 0.001). No matter in male or female, when BMI <24 kg/m2, and WC male <85 cm, female WC <80 cm, the average blood pressure levels and prevalence of hypertension are the lowest; after adjusting for age and other risk factors, the prevalence rate of overweight and obesity for male with hypertension OR are 1.704 (1.592-1.825) and 3.710 (3.148 -4.371) , respectively, for female is 1.527 (1.428-1.632) and 3.014 (2.668-3.405), respectively. When the WC is higher than the standard, male and female hypertension risk OR and 95% CI are 1.231 (1.153-1.314) and 1.353 (1.269-1.442), respectively.</p><p><b>CONCLUSION</b>Both BMI and WC are risk factors of hypertension.</p>

Value of measuring ankle brachial index for diagnosing peripheral arterial disease in Chinese patients with high cardiovascular risk / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the value of measuring ankle brachial index (ABI) for diagnosing peripheral arterial disease(PAD) compared with conventional digital subtraction angiography (DSA) as the reference standard.</p><p><b>METHODS</b>A total of 383 consecutive inpatients (245 male, mean age 64.1 +/- 11.7 years) underwent both conventional DSA and ABI measurements.</p><p><b>RESULTS</b>The rate of statin intervention was 90.9%, ACEI 69.2%, antiplatelet 96.6% and beta-blockers 67.9%. The intravascular stenosis was classified into six degrees: normal, < 30%, 30% - 49%, 50% - 69%, 70% - 89% and > or = 90%. Compared to the traditional gold standard (DSA) in diagnosis PDA, the ABI value decreased in proportion to the severity of PAD (the ABI value was 1.08 +/- 0.11, 1.05 +/- 0.16, 0.99 +/- 0.17, 0.66 +/- 0.24, 0.55 +/- 0.28 and 0.54 +/- 0.00 respectively in the six ranks). There was a significant correlation between DSA and ABI in diagnosis PAD.</p><p><b>CONCLUSION</b>ABI measurement is an accurate and reliable non-invasive alternative to conventional DSA in the assessment of lower extremity arteries in patients with peripheral arterial disease.</p>

Primary risk factors in Chinese patients with first acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the primary risk factors of patients with first ST elevation acute myocardial infarction (FSTEMI) in Beijing and Shenyang area between 2004--2005. The Attributable risk percentage (ARP) and population attributable risk percentage (PARP) of every risk factor were determined.</p><p><b>METHOD</b>A total of 426 consecutive FSTEMI patients and 426 gender and age matched healthy controls were included in this 1:1 matched case-control study.</p><p><b>RESULT</b>Multivariate logistic regression analysis showed that following 8 primary risk factors were associated with FSTEMI: heavy smoking (OR = 3.170), diabetes (OR = 2.835), positive family history (OR = 2.243), lack of soybeans intake (OR = 2.243), higher psychological stress (OR = 2.138), lack of fish intake (OR = 1.740), lower education level (OR = 1.572) and recent adverse life events (< 6 months before FSTEMI, OR = 1.515). The ARP are 71.53%, 58.33%, 54.05%, 40.81%, 56.85%, 41.53%, 48.62%, 54.00%; the PARP are 38.79%, 10.40%, 4.69%, 33.72%, 36.03%, 24.96%, 29.56%, 14.83%, respectively.</p><p><b>CONCLUSION</b>In this patient cohort, the harmful risk factors responsible for the development of FSTEMI in Beijing and Shenyang areas during 2004--2005 are heavy smoking, higher psychological stress, lack of soybeans intake, lower education level, lack of fish intake, recent adverse life events, diabetes and positive family history.</p>

Remote postconditioning by brief renal ischemia and reperfusion reduces acute myocardial ischemia and reperfusion induced myocardial apoptosis in rabbits / 中华心血管病杂志

<p><b>OBJECTIVES</b>To observe the effects of renal ischemic postconditioning (RI-Post) on myocardial apoptosis in rabbits with acute myocardial ischemia and reperfusion.</p><p><b>METHODS</b>All rabbits were subjected to 60 minutes ischemia by left anterior descending coronary artery occlusion (LADO) and 6 hours reperfusion. The rabbits are randomly divided into 3 groups (n = 8 in each group): (1) Ischemia-reperfusion (IR): LADO and reperfusion without additional intervention; (2) RI-Post: after 60 minutes of LADO, the left renal artery was occluded for 30 seconds and reperfused for 30 seconds and repeated 3 times, then the coronary artery was reperfused for 6 hours; (3) Medication intervention (MI): 10 minutes before coronary reperfusion, rabbits were treated with PKC antagonist GF109203X (0.05 mg/kg, IV), followed by RI-Post treatment and 6 hours coronary reperfusion. Myocardial apoptosis was measured by TUNEL and the myocardial Bcl-2 and Bax protein expressions were assessed by immunohistochemistry.</p><p><b>RESULTS</b>Compared with the IR group and the MI group, myocardial apoptosis was significantly reduced (P < 0.05) and the Bcl-2 protein expression increased (P < 0.01) while the Bax protein expression decreased (P < 0.05) in the RI-Post group.</p><p><b>CONCLUSIONS</b>Remote renal postconditioning applied right before the onset of coronary artery reperfusion can reduce the myocardial apoptosis induced by myocardial ischemia and reperfusion and up-regulate Bcl-2 while down-regulate Bax expression possibly by activation of protein kinase C.</p>

Inhibition of Hyperplasia of Vascular Smooth Muscle Cell by RNA Interference of The Plasmids of Cysteine-rich61 / 中华高血压杂志

Objective To investigate the effect of RNA interference plasmids of cysteine-rich 61(Cyr61) on hyperplasia of vascular smooth muscle cell (VSMC) in rats.Methods The plasmids containing the short hairpin RNA (shRNA) of Cyr61 were constructed.Expression of Cyr61 mRNA and protein were detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blotting.The hyperplasia of VSMC was assessed by MTT.DNA synthesis was measured by incorporating ~3H-TDR.Plasmid construction was confirmed by DNA sequencing.Results PCyr61-shRNA transfection significantly decreased the level of mRNA and protein of Cyr61 in VSMC.The cell number,optical density and concentration of DNA in pCyr61-shRNA group were significant decreased(P

Determining the relationship between coronary artery and coronary sinus and its tributaries using multislice computed tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To obtain the coronary artery and coronary sinus (CS) and its tributaries imaging with multislice computed tomography (MSCT), measure the distance between coronary artery and CS and its tributaries and analyze their spatial relationships.</p><p><b>METHODS</b>The MSCT scans of 117 patients (67 men, 50 women, age 56 +/- 10 years) were obtained, 3D image reconstructed and the vessels courses evaluated. The concomitant distances and spatial relationships of the vessels were determined.</p><p><b>RESULTS</b>Right coronary artery domination was found in 107 cases (91.4%), left coronary artery domination in 7 cases (6.0%), and co-domination in 3 cases (2.6%). Left circumflex artery (LCX) was concomitant with CS or the great cardiac vein (GCV) in 81 cases (69.2%), intersected with left posterior vein in 62 cases (53.0%) and with middle cardiac vein (MCV) in 5 cases (4.3%), respectively. The dominant coronary artery branched out into the posterior descending artery (PDA) and the left posterior artery (LPA) in 112 cases (95.7%). PDA was concomitant with MCV in 93 cases (79.5%) and intersected with MCV in 44 cases (37.6%). LPA was intersected with MCV in 106 cases (90.6%), and concomitant with CS in 50 cases (42.7%).</p><p><b>CONCLUSIONS</b>MSCT is a reliable tool to visualize the relationship between coronary artery and CS and its tributaries. Owing to the multiple possibilities inherent to this technique, MSCT has broad potential for more clinical use.</p>

Exploration on the relationship between thrombosis and stability of coronary atherosclerotic plaque in patients with unstable angina pectoris / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the correlation between thrombosis and stability of atherosclerotic plaque within criminal vessels in patients with unstable angina pectoris (UAP) by coronary angioscopy, to explore the clinical pathological basis for acute coronary syndromes (ACS).</p><p><b>METHODS</b>Sixty-eight patients with UAP were enrolled, the patients with post-infarction angina pectoris and variant angina pectoris were excluded. There were 48 males and 20 females, aged from 40 to 73 (average 62.4 +/- 8.6) years. The criminal vessels of there patients were observed by coronary angioscopy during percutaneous coronary intervention (PCI) therapy.</p><p><b>RESULTS</b>There were 68 criminal vessels in 68 patients. Atherosclerotic plaques were observed in all criminal vessels. Among criminal vessels, thrombi and intimae lesions were detected in 63 cases and 46 cases, respectively. Among 68 cases with atherosclerotic plaques, there were 48 cases of yellow plaques (70.5%), 18 cases of light yellow plaques (26.5%) and 2 cases of white plaques (2.94%). Sixty-three thrombi cases were mural and on-occlusive, which included 11 cases of red or mixed thrombi (17.5%) and 52 cases of white or pink thrombi (82.5%). All intimae lesions were accompanied by thrombosis, which included 11 cases of red or mixed thrombi (23.9%) and 35 cases of white or pink thrombi (76.1%).</p><p><b>CONCLUSION</b>The study has shown that the rupture of unstable yellow plaque and its thrombosis were the pathological basis of UAP. Therefore, stabilizing yellow plaque before its rupture may play critical role in prevention and treatment of ACS.</p>

The diagnosis and therapy of chylous ascites / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis and therapy of chylous ascites.</p><p><b>METHODS</b>To diagnose 40 patients of chylous ascite with regular test and quantitative analysis of chyle, direct lymphangiography, CT (immediately after direct lymphangiography), lymphangioscintigraphy, MRI. Twenty-two patients received conservative therapy, 18 patients received retroperitoneal lymphangiectomy and (or) lymph-vein shunting.</p><p><b>RESULTS</b>Lymphatic dysplasia and chylous reflux were found in almost every patient, total parenteral nutrition showed good results. Followed up from 1 month to 5 years, in conservative therapy group, 9 patients were controlled well clinically, the condition of 6 patients was improved better. Seven patients showed no effect. In operation group, 11 patients were controlled well clinically. Four patients got mitigated. Total 7 patients died, although 4 of them ameliorated temporarily.</p><p><b>CONCLUSIONS</b>Direct lymphangiography, CT (immediately after direct lymphangiography) are the most important diagnosis methods. The influence of the therapy to the malformed lymphatic system of patients should be well considered. Lymph-vein shunting, such as thoracic duct-left external jugular vein anastomosis, gastroenteral or retroperitoneal lymphatics-testicular or ovarian vein anastomosis, could improve the circulation of lymph and chyle of patients. Lymphatic microsurgery will play more and more important roles in the treatment of chylous diseases.</p>